1. INTRODUCTION:

Globally in all health care systems, major changes have taken place. The modern health care system is experiencing major changes such as: cost effective care, early hospital discharge and high burden of patients with acute and chronic diseases. These escalating changes in health care systems influence quality of nursing care, job satisfaction of nurses and patients perception of nursing care. Many studies reveal Nurse’s dissatisfaction and turnover result from many factors which includes quality of the working environment, the patient-to-staff ratio, respect for nurses, nurses’ professional autonomy, relationships between staff members and leaders, commitment to the organization and the amount of stress experienced.¹ Dissatisfied nurses may be distracted from their patients, fail to provide holistic care which leads to a lower quality of nursing care. All of these factors together may have a negative impact on patients’ perception of quality care.

While several recent studies have described the relationship between nurses’ job satisfaction and their perceptions of the practice environment and quality of care.^1-3 There was a positive relation between ppatients’’ perception of overall quality care and general job satisfaction of nursing staff.²The present study focus on the relationship of patients’ perceptions of the quality of care with nurses’ job satisfaction and related demographic factors of patients’ satisfaction of quality care and job satisfaction of nursing staff.

Many studies reveals that patients’ satisfaction was highly correlated to proportion of patient-to-nurse ratio and nurses working experiences and the factors “values” and “work” significantly explained the nurse-perceived quality of care and patients were highly satisfied with the care in general.^4-7Hence nurses are the main stream of health care system for providing 24 hour care to patients. To improve patients’ satisfaction, nurses must render quality nursing service which may reflect in their level of job satisfaction.

2. STUDY OBJECTIVES:

1. To find the factors of job satisfaction of nursing staff and patients ‘perception of the quality of care through job satisfaction scale and Human Caring Scale.

2. To find the relationship between job satisfaction of nursing staff and patients ‘perception of the quality of care.

3. Identify differences in the patients’ perception of the quality care in relation to selected independent variables.

4. Identify differences in the job satisfaction of nursing staff in relation to demographic variables.

3. MATERIALS AND METHODS:

a) Study sample and methods

A pilot study (co-relational study) was conducted in a teaching-hospital of Odisha, India during three months period. A total 384 patients and 141 staff nurses were participated in this study aged 15 years old and above, which were selected through convenience sampling method. Data relating to the job satisfaction of nursing staff were collected with the assistance of nursing in-charges in the hospital. The researcher made contact with individual nursing staff and the patients of various unit of the hospital during a three months period to explain the study purpose and how data should be collected. The structure questionnaire was distributed among nursing staff and patients were interviewed to collect their basic information and perception of quality care.

b) Instrument: The tool was divided into two parts to collect data

The Part I:

a) Consists of Socio-demographic characteristics of the patients

b) Consists of Socio-demographic characteristics of the Nursing staff.

Part II:

a) Job satisfaction scale: Job satisfaction of nursing staff was measured using the Kuopio University Hospital Job Satisfaction Scale (KUHJSS), which was adopted and modified from a study done by Tarja Kvist et.a². It consists of seven areas(37 items): I-Leadership, II- Working resources, III- Motivation factors, IV-Working environment, V- Working welfare, VI-Independence, VII-Sense of community and 5-point Likert scales ranging from strongly disagree to strongly agree (1 to 5 points) were used for all the 37 items

b) Patients’ perception of quality care measurement scale: Revised Human Caring Scale (RHCS) was used to measure patients’ perception of quality care, which was adopted and modified from a study done by Tarja Kvist et.al ^2.It consists of six areas(46 items): I-Mutual respect, II-information, III-basic need, IV-Expertise, V- staffing adequacy, VI-pain relief and 5-point Likert scales ranging from strongly disagree to strongly agree (1 to 5 points) were used for all the 46 items.

Table 3. Socio-demographic data of patients (N=384)

Characteristics

Frequency (%)

Characteristics

Percentage (%)

Gender

Male

Female

Age group(years)

15-44

45-54

55-64

>65

Education

Post graduate and above )

Graduate )

Secondary )

Primary School

Illiterate

Place of Residence

Urban

Rural

Living

Alone

With a spouse / Family

Type of Hospital Unit

OPD

IPD

201(52.3 )

183(47.7)

97(25.26)

122(31.77)

89(23.18)

76(19.8)

42(10.94)

44(11.46)

134(34.89)

78(20.31)

86(22.39)

267(69.53)

117(30.47)

64(16.67)

320(83.34)

205(53.39)

179(46.61)

Religion

Hindu

Christian

Muslim

Others

Family monthly income (INR)

Below 2000

2001 – 4000

4001 – 6000 )

Above 6000

Occupational status

Employed

Self-employed

Farmer

Labourer

Hospital admission

Planned

An emergency

Reason for admission to hospital

Examination

Treatment

315(82)

12(3.12)

56(14.58)

01(0.26)

86(22.4)

131(34.1)

98(25.5)

69(17.96)

72(18.75)

64(16.67)

161(41.93)

87(22.66)

255(66.5)

129(33.5)

138(36)

246(64)

Table 4. Socio-demographic data of nursing staff (N=141)

Characteristics

Percentage (%)

Characteristics

Percentage (%)

Gender

Male

Female

Age

<30 years

30-39 years

40-49 years

50-59 years

>59 years

Religion

Hindu

Christian

Muslim

Others

Professional position

Nursing supervisor

Assistant Nursing supervisor

Ward supervisor

Ward nurse / staff nurse

63(44.68)

78(55.31)

02(1.41)

92(65.25)

44(31.20)

02(1.41 )

01(0.7)

87(62)

17(12)

34(24)

3(2)

04(2.84)

08(5.67)

28(19.85)

101(71.63)

Working hours

Day duty

Shifty duty

Typeof employment

Permanent

Temporary

Work experience

<1 year

2–5 years

6–10 years

11–20 years

>21 years

Type of Hospital Unit

OPD

IPD

04(2.84)

137(97.16)

133(94.32)

08(5.67)

04(2.83)

17(12.05)

62(43.95)

53(37.59)

05(3.55)

71(50.35)

70(49.64)

Table 5. Patients’ perception of quality care and relation with selected demographic variables (n=384)

Background variable

1 (M)

II( M)

III (M)

IV (M)

V(M)

VI(M)

Total (M)

Gender

Female (n = 63)

Male (n = 78)

3.44

3.66

.025

3.23

3.07

<.001

4.31

3.62

<0.05

3.34

3.21

<.001

3.12

3.23

<0.05

3.69

3.54

3.01

2.90

Age

15-44

45-54

55-64

>65

2.63

2.60

2.68

3.43

<.0001

3.85

3.75

4.11

4.20

<.0001

4.16

3.79

3.68

4.29

<.0001

3.34

2.31

2.25

3.47

<.0001

4.16

3.12

3.15

4.25

3.52

3.54

3.58

3.63

<.0001

3.09

2.73

2.77

3.32

<.0001

Educational status

Postgraduate and above

Graduate

Secondary

Primary School

Illiterate

3.89

3.61

3.83

3.74

3.78

3.52

2.98

3.05

3.25

3.21

4.38

4.17

4.14

4.15

4.11

3.77

3.31

3.26

3.54

3.43

4.35

4.12

4.05

4.12

4.13

.016

3.97

3.54

3.59

3.70

3.63

3.41

3.10

3.13

3.21

3.18

Place of Residence

Urban

Rural

3.68

3.78

3.12

3.41

.026

4.32

4.69

.016

3.34

3.35

3.13

3.11

3.69

3.79

3.04

3.16

.004

Occupation

Employed

Non-employed

3.78

3.69

4.21

3.07

.016

4.11

4.12

3.43

3.35

4.23

4.16

3.63

3.58

3.34

3.13

Monthly Income

status

Low

Average

High

3.76

2.63

2.65

3.34

2.87

3.05

.026

3.26

4.13

3.24

.016

3.60

3.19

3.41

4.23

4.16

4.25

3.64

3.59

3.52

3.11

2.93

2.87

Hospital admission

Planned

Emergency

3.67

3.35

2.96

3.05

4.21

4.34

<.0001

3.41

3.21

.016

4.11

4.05

3.57

3.60

.016

3.13

3.08

.026

Hospital unit

OPD (n =76 )

IPD (n = 65)

3.78

3.77

.016

3.36

3.13

.016

4.22

4.24

3.48

3.38

4.44

4.22

.001

3.68

3.59

3.28

3.65

<.001

I-Mutual respect, II-information , III-basic need, IV-Expertise, V- staffing adequacy, VI-pain relief , M-Mean

Table 6. Factors Related to Job Satisfaction of nursing staff and relation with selected demographic variables. (n=141)

Background variable

1 (M)

II( M)

III (M)

IV (M)

V(M)

VI(M)

VII(M)

Total (M)

Gender

Female (n = 63)

Male (n = 78)

4.56

4.28

.024

3.33

3.27

3.31

3.42

<.001

3.67

3.54

4.22

4.32

3.13

3.32

.005

3.56

3.35

.026

3.68

3.64

Age

<30 years (n = 02)

30–39 years (n =92)

40–49 years (n = 44)

>51 years (n = 03)

3.68

3.65

3.62

3.73

<.0001

3.95

2.95

3.21

2.76

<.0001

3.11

3.09

4.18

4.29

<.0001

3.14

3.21

3.35

3.67

<.0001

3.13

3.20

3.43

3.65

4.03

3.36

3.56

4.36

.016

2.70

2.56

2.66

3.88

<.0001

3.39

3.14

3.43

3.76

<.0001

Occupational group

Nurse supervisor (n = 04)

Assistant Nsg sup (n = 08)

Ward In charge (n = 28)

Ward nurse (n = 101)

4.89

4.61

3.83

3.74

<.0001

4.52

3.98

3.25

<.0001

4.36

4.27

3.14

4.65

<.0001

3.87

3.41

3.36

3.64

<.0001

4.45

4.22

4.15

4.22

<.0001

4.17

3.26

3.17

3.42

<.0001

4.14

3.61

3.71

<.0001

4.34

3.90

3.51

3.80

<.0001

Work experience

<1 year (n = 4)

2–5 years (n = 17)

6–10 years (n = 62)

11–20 years (n = 53)

>21 years (n = 05)

3.68

3.59

3.53

3.63

4.55

4.31

3.27

3.46

3.66

4.15

<.0001

4.15

3.32

34.31

3.42

4.54

4.53

3.43

4.35

3.49

4.68

.047

3.23

3.26

3.61

3.54

3.35

3.52

3.41

3.23

3.34

3.28

3.76

3.62

3.64

3.67

3.68

.008

3.88

3.41

3.60

3.53

4.03

<.0001

Employment

arrangement

Permanent (n = 137)

Temporary (n = 04)

3.87

3.41

3.12

3.41

.016

4.25

3.09

.026

4.34

3.38

4.14

4.12

3.37

3.38

3.68

3.76

3.82

3.50

Work shifts

Day shift (n = 04)

Rotational shift (n = 137)

3.75

3.67

<.0001

3.36

2.68

<.0001

4.28

4.23

<.0001

4.60

4.19

<.0001

4.59

4.26

<.0001

3.64

3.28

<.0001

3.70

3.69

<.0001

3.98

3.71

<.0001

Hospital unit

OPD (n =76 )

IPD (n = 65)

3.78

3.67

<.0001

3.44

3.23

<.0001

4.33

4.34

.001

3.48

3.38

.033

4.24

4.26

<.0001

3.38

3.35

<.0001

3.77

3.72

<.0001

3.77

3.70

<.0001

I-Leadership, II- Working resources, III- Motivation factors, IV-Working environment, V- Working welfare VI-Independence ,

VII- Sense of community (M-Mean)

5. DISCUSSION:

The findings from this study indicated that patients’ perceptions of overall quality of care were positively related to the general job satisfaction. Similar type of study conducted in Finland and found that patients’ perceptions of overall quality of care were positively related to the general job satisfaction reported by nursing staff and patients who were cared for in outpatient departments felt more respected than patients cared for on hospital wards.²

The findings from this study indicated that a vast majority (82.8%) of the respondents were satisfied with almost all aspects of nursing care they received. Similar study findings in the Iranian Centre for Breast Cancer ravels that 82% of these patients were satisfied^3. Also, this finding is similar with the finding of Davidson et al. on 430 patients with the six most commonly diagnosed cancers in Northern Ireland. The latter study showed over 70% of the patients was satisfied with the various stages of their care during the hospitalization.⁴

The present study showed that male patients were having more perception of quality care in respect to mutual respect, information and staff adequacy than female patients. This finding is contrary with a descriptive, correlation study conducted by Chan and Chau in one urban acute hospital in Hong Kong, who suggested that the gender of the patients did not affect their overall satisfaction^.5In contrast, in the study conducted by Brian et al on 684 inpatients those receiving nursing and surgical care for cardiovascular, respiratory, urinary and locomotors system diseases at Nancy University Hospital in northeast France reported men tended to be more satisfied than women from the nursing and daily care, medical care, information, hospital environment.⁶

The present study showed that significant relationship was found between age and patients’ perception of quality care that is older patients were more satisfied than younger(p<0.01). A similar finding from a study conducted by Pitaloka et al on 150 women in HUKM hospital in Kuala Lumpur reported no significant relationship between age and patients’ satisfaction^{. 7} This result contradicts with the findings of the studies^{2, 8, 9, 10}. They reported that age was associated with the patients’ satisfaction, and older patients were found to report a slightly higher satisfaction than younger patients. A likely explanation to their finding is that older people could be placing greater value on the nursing care they receive when their own need of care is at its greatest.

This study showed that there was no relationship between the family monthly income of the patients and their overall satisfaction with nursing care. On the contrary, a study reported that patients with higher income tended to be less satisfied with nursing care^.¹¹But similar result reported in the study conducted 425 cancer patients in Iranian Canter for Breast Cancer in Tehran City^{. 3} In their study, they proposed that no relationship existed between family income and patients’ satisfaction. However, a study among 1245 respondents in London reported that patients with lower income were less satisfied with the nursing care they received^.12

Significant relationship was indicated for the type of units, type of admission and patients’ level of satisfaction in the current study. In the same vein, similar finding was observed in a study conducted in Finland.²This is contradicted with the result of a study in which it was reported that patients, admitted in private rooms, were found to be more satisfied with the nursing care rendered to them^{. 6, 13}

However, nursing is also very demanding profession and this study found that their job satisfaction is positively related to patients’ satisfaction of quality care. The lowest job satisfaction scores were related to the requiring factors of the work. Previous studies conducted in Finland and Iran^{2, 3}and other places^14-18identified low job satisfaction are associated with low staffing levels. The nurses’ reported due to the bureaucracy of the Finnish health care system reflected their lack of opportunities to participate in decision-making.¹⁹The results of this survey demonstrate that the nursing leadership in Indian set up hospital will have to evolve and take on a transformational role if general job satisfaction is to be raised. Nursing supervisor reported the highest job satisfaction of all nurses who responded. The most satisfied nursing staff members were those who considered the quality of care provided by their working unit to be excellent. This relationship between job satisfaction and quality of care has been observed in previous studies.^{16, 15, 20}

The quality care provided by nursing staff will reflect the patients’ satisfaction of quality care which was also observed in the present study.

6. CONCLUSION:

Generally job satisfaction of nursing staff is an important aspect for quality care, as evaluated by the patients. It is vital to support the well-being of staff because this has the potential to improve patients’ perceptions of quality care. Further research is also needed to find the other important reasons of patients’ satisfaction of quality care and factors of job satisfaction of nursing staff so that quality care can be provided to patients, because they are the main stream of health care system for providing 24 hour care to patients.

7. LIMITATION:

There are several limitations to the design of this study. One limitation is related to the selection bias. This was due to the fact that the participation in the study was based on voluntary basis, usually those voluntary are satisfied and don’t have complain from the nursing care. Consequently increase the result of satisfaction from nursing care. On the other hand, a small version of study (pilot study) with less sample size and in one hospital is not enough to detect any significant association between socio-demographic characteristics and level of satisfaction of patients and nursing staff.

8. IMPLICATIONS:

From the findings of the study the following implication are stated.

-Present study would help nurses and other healthcare personnel to understand the factors of patient satisfaction.

- The findings would help the health policy for planning and developing proper staffing pattern and provide opportunity for their job satisfaction so that quality nursing care can be given to patients.

-The nurse administrator would support the well-being of staff because this has the potential to improve patients’ perceptions of quality care further recommend practicing the hospital protocol for better quality care for patient satisfaction.

9. RECOMMENDATIONS:

-This type of study may be conducted in different hospitals and in various setting (private and govt. hospitals) of India to know the factors and rate of patients’ satisfaction and job satisfaction of nursing staff.

-This type of study may be conducted in large no of sample to find out the relationship between job satisfaction of nursing staff and patients’ perception of quality care.

-Training strategy for health professional may be implemented to improve patients’ satisfaction of quality care.

10. ACKNOWLEDGEMENTS:

I would like to thank all the patients and nursing staff, who took part in the study and gratefully acknowledge the management and staff of the hospital involved in this study, in Odisha state.

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Received on 21.08.2015 Modified on 24.08.2015

Asian J. Nur. Edu. and Research 6(3): 2016; 283-291.

DOI: 10.5958/2349-2996.2016.00054.9